Labia Majora Research Articles

An Unusual Case of Large Vulvar Soft Fibroma In An Adult Patient: A Case Report

A 25-year-old female patient applied to our clinic with a complaint of a growing mass in external genitalia. Patient’s complaint began 10 years ago as a small papillomatous lesion in the right labia majora, which increased in size progressively reaching to present size of 20-30 cm in 2-3 years after the first symptom. The mass was prediagnosed as vulvar soft fibroma, and surgical excision was decided. The histopathological findings were compatible with fibroepithelial polyp .The patient had no postoperative complication, and there was no residue or recurrence at the last assessment on postoperative 3rd month.

Multifocal Infantile Hemangiomas Treated by Oral Itraconazole: A Case Report

We describe a case of a 2-month-old girl presented with more than 60 papules and nodules of hemangiomas involving the skin of the sclera, endocanthion, lower lip, and labium majus pudenda without visceral hemangiomas and laboratory abnormality. A skin biopsy showed numerous scattered, clearly limited, irregular cellular lobules in the dermis circumvoluted into capillaries comprising incomplete vessel walls, which was consistent with a diagnosis of multifocal cutaneous infantile hemangioma. Oral treatment with itraconazole (5mg/kg/day) for 26 weeks resulted in predominantly involution of the skin hemangiomas. We would like to report a rare case of multifocal cutaneous infantile hemangioma, successfully treated with oral itraconazole.

Vulval fibroadenoma, a common tumor at an uncommon site - A case report with review of literature

Vulval fibroadenoma is a rare benign tumour arising from anogenital mammary like glands. Vulva is an uncommon site for fibroadenoma. This is a case of 33 year old female presented with well defined mass in the right labia majora with a histopathological diagnosis of Vulval fibroadenoma confirming origin from ectopic breast tissue.

Hair Tourniquet around Labia Majora: A Case Report and Literature Review

Hair tourniquet syndrome (HTS) is a condition where the hair or thread wrapped around part of the body accidently. Commonly found around the toe but it can occasionally be found around the fingers, external genitalia and anywhere else. Here in our case we want to mention the importance of proper exam of the genitalia especially if the patient has chronic pain and tenderness at the genital area to exclude hair tourniquet as one of the differential diagnosis.

26 Hydrocele of the canal of nuck: Case report

Introduction: Hydrocele of the canal of Nuck is a rare condition caused by a failure of complete obliteration of the canal of Nuck and it is more common in female children. The processus vaginalis accompanies the round ligament through the inguinal canal into the labium majus. This evagination of the parietal peritoneum forms the canal of Nuck in females. The canal of Nuck normally loses its connection with the peritoneal cavity during the first year of life, but in some rare cases, it can result in a hernia or hydrocele when the connection of the canal of Nuck fails to close.

Chronic Vulvar Plaque in a Patient With Severe Hidradenitis Suppurativa

A 38-year-old woman with long-standing severe hidradenitis suppurativa presented to our dermatology clinic with an asymptomatic, slowly enlarging growth on the right labium majus of 2 years’ duration. She also had severe persistent drainage from nodules and sinus tracts involving the abdominal pannus, inguinal folds, vulva, perineum, buttocks, and upper thighs.

Aggressive (deep) angiomyxoma of the vulva: a case report\xa0

BackgroundAggressive angiomyxoma of the vulva is a benign, slow-growing tumor originating from myxoid cells of connective tissue. The tumor is known for multiple local recurrences with a low tendency to metastasize. Only around 350 cases have been documented in the scientific literature so far.Case presentationWe report a case of a 40-year-old North Indian, unmarried woman with a swelling on the left labium majora for 7 years, along with surface ulceration over the mass. Local examination showed a well-circumscribed, 8 × 8 cm pedunculated mass arising from the left labium majora with an overlying ulcer measuring 6 cm × 4 cm. After taking informed written consent, wide local excision of the mass and surrounding margins was done under anesthesia. Histopathology was suggestive of aggressive angiomyxoma. Immunohistochemistry was done, which was positive for estrogen and progesterone receptors. Her postoperative recovery was uneventful. The patient was given three doses of gonadotropin-releasing hormone agonist (injection, leuprolide 3.75 mg) once a month. No recurrence has been reported so far on follow-up visits for 1 year.ConclusionAggressive angiomyxoma is one of the differential diagnoses for vulvovaginal growth in a female. As the tumor is well known for local recurrences, correct diagnosis and appropriate management using a multidisciplinary approach are crucial to managing such patients.

The skin in Behçet's disease: Mucocutaneous findings and differential diagnosis

AbstractBehçet's disease (BD) is a chronic multisystemic inflammatory disease with vasculitis and skin findings. Attacks and remissions characterize the course of the disease. In general, the disease activity decreases with advanced age. Skin symptoms are characteristic of BD and they are the most common findings in the course of the disease. The earliest sign of the disease is almost always recurrent oral aphthous ulcers. Genital ulcers are very specific for BD and they are the equivalent of oral ulcers in the genital area. The most common location is labium majus in females and scrotum in males. The papulopustular lesions are mainly observed on the lower extremities in BD patients. Erythema nodosum‐like lesions and superficial thrombophlebitis are relatively common skin findings. Extragenital ulcerations presenting on the intertriginous area are rare but specific for the disease. The clinical skin manifestations are crucial for the diagnosis of BD, as there is no pathognomonic confirmatory laboratory test.

Fibroma of perineum, a rare entity in children: Two congenital cases

Two cases of perineal polypoid-like lesions in children are described. The first patient is a 21 months old girl with a congenital perianal pedunculated asymptomatic lesion, covered by normal skin, not increased in size since birth (Figure 1). A MRI showed a lesion localized at right side of median raphe, in contact with external anal sphincter, without any apparently fistula and no dystrophy of raphe or sacrum (Figure 2). A surgical resection was performed. Histological examination revealed a soft fibroma. Post-operative period did not presented complications or recurrence. The second patient is a 7 months old girl derived to Pediatric Surgery Department of Verona Hospital for the presence of a mass localized in the left labium majus (Figure 3). The lesion was soft, pedunculated, asymptomatic and it has been increased in size since birth.

Treatment of a Chronic Vulvar Wound by Hyperbaric Oxygen Therapy (HBOT)

We hereby report the case of a 66-year-old obese patient (BMI 30) with type 2 diabetes, who presented a chronic vulvar lesion on the left labia majora following surgical drainage of an abscess. After multiple unsuccessful treatments by antibiotics and local wound care, we proposed a trial of hyperbaric oxygen therapy (HBOT). The patient fully recovered after 54 sessions at 2.5 ATA, 95 minutes each. HBOT has been studied for perineal lesion such as skin atrophy or necrosis caused by irradiation but not for vulvar nonhealing chronic lesions in the case of impaired vascularization caused by diabetes. This case is, to our knowledge, one of the first publications about the healing boost of HBOT in chronic vulvar wounds due to vascular impairment.

Hair tourniquet syndrome of labia minora: case report.

Hair Tourniquet Syndrome (HTS) is defined as strangulation by a hair thread of the appendage of the human body, especially in the children population, it rarely occurs in external genitalia (clitoris, labia majora and minora). Herein, we aimed to present a rare occurrence of HTS around the labia minora in a 12-year-old child treated by excision of the cystic lesion with an uneventful follow-up. Special care should be given to every swollen appendage in children to avoid severe consequences such as amputation and disfigurement.

Myiasis by <em>Dermatobia hominis</em> larvae in a post-menopausal patient having ulcerative vulvar carcinoma

68 years old, post-menopausal, multiparous, female having carcinoma of vulva extending up to urethra. She was having foul smelling blood stained discharge with poor personal hygiene was referred from a primary health centre. On examination there was large necrotic cauliflower like growth at labia majora and large number of larva of Dermatobia hominis were crawling in necrotic tissue.Larvae were removed followed by cleansing of the affected area and a course of antibiotics was given. Patient was referred to Oncology Deptt. for further management of vulvar malignancy.

Genital Psoriasis: A Prospective, Observational, Single-Centre Study on Prevalence, Clinical Features, Risk Factors, and Its Impact on Quality of Life and Sexual Health.

Background:Genital psoriasis is often under-recognized and the exact burden is unknown in Malaysia.Objectives:To identify the prevalence of genital psoriasis, its clinical features, risk factors, and impact on quality of life and sexual health.Methods:This prospective, observational study was conducted in the dermatology clinic of our hospital from 1st September 2020 until 31st March 2021, involving all adult patients with psoriasis. The genital examination was performed and the subjects were interviewed using questionnaires.Results:A total of 262 patients were recruited, with a male to female ratio of 1.5:1 (mean age of 51 years old). They comprised 42.0% Chinese, followed by 36.6% of Malay, 21.4% of Indians and others. Up to 46.1% of patients had a current or history of genital psoriasis. The most common area involved for males was the scrotum (44.1%) and labia majora (62.5%) for female patients. Itching (79.2%) was the most frequent symptom encountered. Chinese patients had 2.67 times odd (CI 1.55-4.61) of having genital psoriasis compared to non-Chinese patients. Other independent risk factors included flexural involvement, male gender, and Type 1 psoriasis. Genital psoriasis was associated with greater impairment on quality of life and sexual health (mean total Dermatology Life Quality Index: 8.8 vs 6.5, P = 0.006), International Index of Erectile Function (mean: 48.5 vs 57.0, P = 0.011) and revised version of Female Sexual Distress Scales (mean: 20.7 vs 11.4, P = 0.022).Conclusions:Genital psoriasis is common and it has a profound impact on patients.

Vulvar granular cell tumour in a recently post-partum woman: a case report

Granular cell tumours (GCTs) are uncommon neuroectodermally derived tumours. Vulvar location is rare with 134 reported cases presenting as a non-specific vulvar mass. They are of low malignant potential and management is local excision. They have a high local recurrence rate if incompletely excised. The GCT diagnosis is often retrospective due to its rarity, its non-specific presenting symptoms and numerous differentials. Here we descibe the case of a 31-year-old woman presenting after an asymptomatic right labium majus mass was noted during a postnatal visit. This was imaged with magentic resonance imaging (MRI) and a biopsy was inconclusive. She was referred for subspecialty consultation at the Chris O’Brien Lifehouse. The lesion was five centimetres, overlying the pubis and inferolateral to the clitoris with no skin changes or epidermal attachment. Wide local excision was performed. Histopathology showed GCT features with no malignant characteristics, but positive margins. Despite positive margins, the decision was made to not complete re-excision and observe for recurrence. This was an unusual case in a young postpartum woman. It highlights the need for clinical suspicion of this tumour type during a postpartum examination and the need for nuanced decision making regarding re-excision based on individual patient needs despite recurrence risk.

Aggressive Angiomyxoma of Vulva

Aggressive angiomyxoma is a rare, slowly growing, and benign tumor of mesenchymal origin that usually occurs in the pelvis and perineum of young females. Steeper and Rosai in 1983, first described angiomyxoma. The term “aggressive” underlines the tumour’s locally infiltrative nature and high risk for local recurrence. The rate of relapse varies from 35% to 72%, however, it rarely metastasizes so it has an overall good prognosis. Diagnosis is mainly made on histopathology after surgical resection. The optimal treatment for aggressive angiomyxoma is wide local excision with tumor free margin. We here report a case of aggressive angiomyxoma in 22 years female who presented with mass on left labia majora.

Microablative Fractional Radiofrequency as a Therapeutical Option for Genitourinary Syndrome of Menopause: Perspectives.

The genitourinary syndrome in menopause can occur at different stages of life, with different causes or triggering factors, such as prolonged use of antiestrogens, chemotherapy, radiotherapy, and extensive vaginal surgeries, which can alter vascularization, hydration, collagen quality, and tissue elasticity. Despite hormonal therapy being considered the best evidenced treatment for genitourinary syndrome of menopause (GSM), there are limitations concerning the latter. Thus, alternative, complementary, or even substitutive treatments have emerged, such as energy use, promoting thermal tissue stimulation to improve tropism. Due to its practicality and feasibility, the micro ablative fractional radiofrequency (MAFRF) has gained space among these energies. It uses high-frequency electromagnetic waves and promotes thermal micro points in the superficial and deep dermis. The safety of these energies limits thermal action laterality and depth. Laterally, it is essential for an adequate regenerative effect without scarring marks or sequelae; the appropriate depth is important for stimulating the obligatory tissue repair response with the production and reorganization of collagen, elastic fibers, increased vascularization and hydration, and the consequent improvement in tropism. In gynecology, the MAFRF is used with therapeutic indication and functional improvement; it is applied to the entire length of the vaginal walls, the vulvar vestibule, urethral meatus, labia minora, clitoris prepuce, labia majora, perineum, and perianal region. The MAFRF has been proved to be an effective and safe treatment for GSM, with long-lasting effects, significantly reducing symptoms and improving vaginal tropism. This review aims to analyze the MAFRF as a non-hormonal therapeutic option for GSM.

Dermatoscopy in the Diagnosis of Vulvar Basal Cell Carcinoma: A Case Report

Abstract Introduction: Basal cell carcinoma (BCC) is the most common human malignancy commonly in white people, but in less than 1% of cases it may appear on unexposed areas, like the perineal and anal regions. Vulvar BCC is often diagnosed late because it grows slowly and tends to be asymptomatic, with no specific physical findings. Here, we present a rare Latin patient with a 10-year history of vulvar BCC with dermatoscopic and histopathologic findings. Case report: A 65-year-old Latin woman presented with a nodule on her left labium majus, which she first noted 10 years ago, and that had grown slowly but constantly. She also reported a 20-year history of pruritus and occasional pain. Physical examination showed a 3.5 cm × 3.0 cm erythematous lesion with a central rough without inguinal lymphadenopathy. Contact dermatoscopy (Dermalite DL3 Gen.) showed one blurred cluster of arborising vessels in a pinkish background with white homogeneous areas and lines radial converging. An incisional biopsy was realized, and histopathology diagnosed BCC. Discussion: Vulvar BCC is a rare malignancy that affects mainly Caucasian women over 70 years of age. The most common etiology for BCC is ultraviolet radiation, but as the vulva is unexposed its cause is unclear. Mutations in tumor suppressor and regulatory genes such as p53 are present in 50% of cases. Gorlin syndrome, chronic radiation, chronic arsenic exposure, xeroderma pigmentosum, and immunosuppression have been considered as risk factors. Conclusion: Vulvar BCC characteristics are the same as other cutaneous forms, featuring blue ovoid nests and arborizing telangiectasia, confused with inflammatory diseases, such as eczema, psoriasis, and chronic infection (especially if it is accompanied by pruritus), this makes diagnosis complex, with a delay of 5 to 6 years on average, with an average size of 2.1 cm. Diagnosis is enhanced with dermatoscopy, as the preferred treatment for most BCC cases is wide surgical excision.

Unusual lesion on the vulva of a postmenopausal woman

Unusual lesion on the vulva of a postmenopausal woman

1412 De Garengeot's Hernia Complicated by Perforated Appendicitis and Groin Abscess: Report of A Rare Surgical Emergency

Abstract Introduction De Garengeot's hernia is a rare subtype of femoral hernia which contains the vermiform appendix. Acute appendicitis in a femoral hernia is even more unusual, accounting for 0.08% - 0.13% of all cases of femoral hernias. Case presentation A 91-year-old woman was referred with a painful, cellulitic right groin mass. A computed tomography scan demonstrated a right-sided femoral hernia containing a loop of bowel and a collection in the right groin containing fluid and gas. The patient had early dementia but no other major medical co-morbidities. At surgery, she was found to have perforated appendicitis in a right femoral hernia. Most of the appendix and sac had fully disintegrated, forming a large abscess cavity beneath the skin in the right groin which extended down to the upper labia majora. The appendix tip was lying deep within the abscess cavity. A modified McEvedy approach was used to access the peritoneal cavity for the appendicectomy and sutured repair of the femoral neck. The groin abscess cavity was drained and managed with a negative pressure (VAC) dressing. Discussion De Garengeot's hernia is often difficult to diagnose pre-operatively and reporting of cross-sectional imaging may not always be reliable. Currently, there is no gold standard method for repairing these hernias. However, the modified McEvedy approach is well-described and is the preferred technique for emergent femoral hernia presentations. It provides sufficient access to manage both appendicitis and the femoral hernia. Adjuncts such as negative pressures dressings may be used to manage concomitant abscess cavities.

A rare case of left Nuck’s canal cystic endometriosis: Computed Tomography findings

Introduction:Endometriosis is a common and chronic gynaecological condition but the implant in the canal of Nuck constitutes a very unusual state with an estimated prevalence of 0.3%–0.6% of all endometriosis cases. The canal of Nuck is an abnormal patent pouch of parietal peritoneum extending anteriorly from the round ligament of the uterus into the labia majora, thus represents a communication between the peritoneal cavity and the female inguinal canal. This condition may permit the seeding of endometriotic tissue in the inguinal soft tissues, becoming a possible cause of inguinal swelling or pain.Case description:A 43-years-old woman presented with painful swelling in her left groin. Ultrasound and a subsequent pelvic computed tomography showed a cystic lesion as for a Nuck’s canal encysted hydrocele. The patient underwent an anterior open surgery and the histologic examination revealed an endometrium-like tissue in the cystic wall.Conclusion:In women presenting with painful swelling of the groin, despite its rarity, endometriosis of the Nuck’s canal must be differentiated from other more common pathologies like hernias, varicoceles, neoplasms, and lymphadenopathies. Imaging can aid in differential diagnosis, but the final diagnosis is entrusted to histology, which enable to exclude an underlying malignancy.